A VA-ECMO használata, tapasztalatok a Városmajori Klinikán

Abstract

Mechanical circulatory support (MCS) was introduced in the 1960s, of which there is short-, mid- and long-term forms. This brief review discusses our experiences with the primary modality used in Hungary, the veno-arterial extracorpo­real membrane oxygenator (VA-ECMO). We introduced the device with the most relevant information and summarized our clinic’s registry with patient characteristics and results in whom we applied this modality next to data of international studies. We collected data retro- and prospectively from 2012 to 2020 from patients treated with the VA-ECMO at our clinic. The primary endpoint we used was all cause mortality in this patient population of critical condition. Every indication, potential peripheral-central conversion and primary operation technique was involved in the analysis. We found that age above 65 and initial pH under 7.2 significantly affects mortality data. Acute coronary syndrome (ACS) as primary indication showed to be nearly significant, and acute rejection after hTX was a beneficial clinical scenario regarding survival. In international literature diabetes mellitus, elevated levels of lactate, kidney- and hepatic insufficiency were identified as contributing mortality predictors as well. Our results mostly coincide with the international mortality and risk factor data. Time is a very important factor for the survival of these patients. Therefore, it is very important to refer the patient’s refractory to non-MCS therapy to centers with VA-ECMO capability in time.

Acute coronary syndrome associated cardiogenic shock in the catheterization laboratory: peripheral veno-arterial extracorporeal membrane oxygenator management and recommendations

“…In approximately half of CS ACS cases, comprehensive and accurate medical and interventional treatment can effectively halt the deterioration of the condition and provide a cure for the patients. However, if CS worsens and potentially or clinically proves refractory to lesser treatment methods, the utilization of extracorporeal life support (ECLS) devices becomes a viable option in dedicated cases (4,7,8).…”